Please, note that two bursae lie near the calcaneal tendon insertion: the retrocalcaneal bursa (between the tendon insertion and the posterior angle of the calcaneus) and the subcutaneous calcaneal bursa (between the tendon and the skin).

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Clinical presentation

Patients present with posterior ankle pain made worse by passive dorsiflexion of the ankle with swelling/erythema in the region of the distal calcaneal tendon 3,4.

Pathology

Retrocalcaneal bursitis rarely occurs in isolation and is almost always associated with calcaneal tendinitis and/or Haglund deformity. The bursa may also be primarily involved by inflammatory or infectious bursitis 4.

Ultrasound

MRI

Bursa distension by a fluid collection:

T1: low signal

T2: high signal

STIR: high signal

Treatment and prognosis

Most patients respond to conservative treatment (e.g. NSAIDs, heel lifts, CAM boot); steroid injections may also be of benefit, but may cause tendinous rupture. Surgical treatment (excision of the bursa) is typically reserved for refractory cases.